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PubMed2003

[Spontaneous cervical spondylodiscitis caused by Salmonella typhi in an immunocompetent patient].

We report a case of spontaneous cervical spondylodiscitis caused by Salmonella typhi. A 52-year-old man presented in the neurosurgical service with complaints of pain in the cervical and scapular region. Cervical inflammatory disease was suggested by bone scintigraphy and magnetic resonance imaging. The diagnosis of Salmonella typhi spondylodiscitis was established by blood culture and culture of needle biopsy specimen taken from the C5 vertebra. The agglutinin titers for Salmonella were elevated. Intravenous ciprofloxacin therapy and external immobilization with a halo vest were instituted. A review of literature was performed evaluating the clinical, diagnostic and therapeutic aspects of this unusual pathology.

Cervical Vertebrae↗
PubMedDate not supplied

[Brucella spondylodiscitis: case report].

Vertebral localization of Brucellosis has a low occurrence nowadays. Because of its rarity, it is essential to pay attention to structural modifications of the vertebral segment caused by bacterial spondylodiscitis. Based on a clinical case, with radiological, anatomicopathological and labatorial aspects related to the diagnostic and also the treatment of this disease, the authors underscore the importance and serious consequences arising from a late diagnostic definition.

Adult↗
PubMed2007

PCR identification of Mycobacterium tuberculosis complex in a clinical sample from a patient with symptoms of tuberculous spondylodiscitis.

A 42-year-old male complaining of thoracic spine pain was admitted to the hospital for evaluation. An X-ray and computer tomography of the thoracic spine showed spondylodiscitis of the L3 lumbar and L2-L3 intervertebral disk. The tuberculin skin test (PPD) was strongly positive. A radioscopy-guided fine needle aspirate of the affected area was cultured but did not reveal the cause of the disease. Two biopsy attempts failed to reveal the cause of the disease by culturing or by acid-fast-resistant staining (Ziehl Neelsen) of the specimens. A third biopsy also failed to detect the infectious agent by using microbiological procedures, but revealed the presence of a 245-bp amplicon characteristic of the Mycobacterium tuberculosis complex after PCR of the sample. The result demonstrates the efficacy of PCR for the identification of M. tuberculosis in situations in which conventional diagnosis by culturing techniques or direct microscopy is unable to detect the microorganism. Following this result the patient was treated with the antituberculous cocktail composed by rifampicin, pirazinamide and isoniazid during a six-month period. At the end of the treatment the dorsalgia symptoms had disappeared.

Adult↗
PubMedDate not supplied

Cervical myelopathy associated with extradural synovial cysts in 4 dogs.

Three Mastiffs and 1 Great Dane were presented to the University of Wisconsin Veterinary Medical Teaching Hospital for cervical myelopathy based on history and neurologic examination. All dogs were males and had progressive ataxia and tetraparesis. Degenerative arthritis of the articular facet joints was noted on survey spinal radiographs. Myelography disclosed lateral axial compression of the cervical spinal cord medial to the articular facets. Extradural compressive cystic structures adjacent to articular facets were identified on magnetic resonance imaging (1 dog). High protein concentration was the most important finding on cerebrospinal fluid analysis. Dorsal laminectomies were performed in all dogs for spinal cord decompression and cyst removal. Findings on cytologic examination of the cystic fluid were consistent with synovial fluid, and histopathologic results supported the diagnosis of synovial cysts. All dogs are ambulatory and 3 are asymptomatic after surgery with a follow-up time ranging from 1 to 8 months. This is the 1st report of extradural synovial cysts in dogs, and synovial cysts should be a differential diagnosis for young giant breed dogs with cervical myelopathy.

Animals↗
PubMedDate not supplied

Gastric mucosal lesions in dogs with acute intervertebral disc disease: characterization and effects of omeprazole or misoprostol.

We characterized gastric mucosal lesions in dogs with acute degenerative disc disease treated by surgery and corticosteroid administration. The effect of omeprazole and misoprostol on gastric lesions in these dogs was also evaluated. Dogs were randomly assigned to 1 of 2 treatment groups or to the control group. Treatment consisted of omeprazole at 0.7 mg/kg orally once daily, or misoprostol at 2 microg/kg orally 3 times daily. All 3 groups received dexamethasone at 2 mg/kg on day 0, prednisolone at 2 mg/kg on day 1. prednisolone at 1 mg/kg on day 2, and prednisolone at 0.5 mg/kg on all further days (range, 5-6 days). Endoscopic examination was performed on day 0 and 5-6 days later. Four regions of the stomach were qualitatively scored from 1 to 12 based on the presence of submucosal hemorrhage, erosion, or ulceration, with ulceration receiving the highest numerical score. Nineteen of 25 dogs had gastric mucosal lesions at the beginning of the study. No significant difference was found in the gastric lesion score among the 3 groups at the end of the study. Gastric mucosal lesions were concluded to be common in dogs with acute degenerative disc disease treated with corticosteroids. Neither omeprazole nor misoprostol at the doses used was effective in healing or preventing the further development of gastric mucosal lesions.

Adrenal Cortex Hormones↗
PubMed2002

Surgical strategy for spondylodiscitis due to Candida albicans in an immunocompromised host.

A 44-year-old woman receiving systemic chemotherapy for cerebellar medulloblastoma developed thoracolumbar spondylodiscitis due to Candida albicans associated with abscesses in the bilateral psoas muscles. As long-term medical therapy with fluconazole was not effective, radical removal of the affected lesions and anterior bone grafting were performed. Corpectomy of the infected vertebra with autologous bone grafting and removal of the psoas muscle were performed via the right transthoracic retroperitoneal approach. Additional posterior instrumentation was not used. Two years after the operation, the patient was doing well, and systemic chemotherapy for medulloblastoma has restarted. Corpectomy with radical resection of surrounding infectious tissues for C. albicans spondylodiscitis in an immunocompromised host should be performed when conservative medical treatment is not successful. Further instrumentation surgery might be necessary to prevent further deformity of the spine as the second surgery.

Adult↗
PubMed2003

Brucellar spondylodiscitis in the lumbar region.

A 59-year-old male farmer presented with a rare case of spondylodiscitis as a manifestation of systemic brucellosis. The patient presented with radicular pain and restricted mobility of the spine due to localized muscle spasm in addition to systemic complaints. Magnetic resonance imaging demonstrated discovertebral involvement at the L4-5 intervertebral space, indicating infectious spondylodiscitis. The Rose-Bengal test was positive and the serum antibody titer was 1/1280. The patient was treated with streptomycin combined with tetracycline plus rifampicin, with complete recovery. Early diagnosis is important and prompt antibrucellar chemotherapy is effective in most cases. Therefore, spondylodiscitis due to brucellosis should be considered in the differential diagnosis of spinal infections.

Anti-Bacterial Agents↗
PubMed2006

CT-guided core biopsy of subchondral bone and intervertebral space in suspected spondylodiskitis.

OBJECTIVE: Our objective was to determine the diagnostic performance of CT-guided core biopsy including both intervertebral disks and subchondral bone in suspected spondylodiskitis and compare the results with those for other biopsy techniques. CONCLUSION: CT-guided core biopsy of subchondral bone and intervertebral space compares favorably to previously published studies because histology can provide the diagnosis even when no specific infectious agent is isolated.

Biopsy↗
PubMed1994

Cervical epidural spinal infection: MR imaging characteristics.

OBJECTIVE: Cervical epidural spinal infection, which includes diskitis, osteomyelitis, and/or epidural space infection, is an uncommon disease, and the MR imaging features have not been fully described. Accordingly, the objective of this study was to determine the MR imaging findings in a large series of patients with this condition, with emphasis on patients with pyogenic infection. MATERIALS AND METHODS: During a 5-1/2-year interval, 12,695 MR examinations of the spine were performed in our department. A computer search retrospectively identified 60 patients with proved epidural spinal infection; 19 (32%) had involvement of the cervical spine. Pyogenic infection was present in approximately 90% of cases. One patient had an epidural abscess without an underlying osseous abnormality. The remaining 18 patients had cervical diskitis/osteomyelitis, as well as inflammation in the epidural space. All MR examinations were performed with a 1.5-T superconducting magnet by using a combination of spin-echo, fast spin-echo, and/or gradient-echo pulse sequences; 12 patients received IV gadopentetate dimeglumine. The MR examinations were retrospectively reviewed by a neuroradiologist for multiple imaging characteristics, including extent and location of osseous abnormalities, extent and location of inflammation in the epidural space, likelihood of abscess formation, and frequency of spinal cord compromise. RESULTS: On MR images, an average of three vertebral bodies showed abnormal signal of the bone marrow. Inflammation in the epidural space extended an average of four levels and was most frequently anterior in location; MR images in six (50%) of 12 patients who received contrast material showed a large, peripherally enhancing epidural abscess. Thirteen (72%) of the 18 infections with osseous involvement occurred at or below the level of C4; the C5 and C6 levels were affected most frequently. Cord compression was identified in 14 (74%) of 19 patients; cord hyperintensity was seen in 12 (63%) of 19 patients and was well defined on T2-weighted FSE images. CONCLUSION: The results of our study show that cervical epidural spinal infection is a more aggressive disease than previously recognized. MR findings are characterized by multilevel involvement, an anterior location, and frequent abscess formation. MR evidence of isolated involvement of the epidural space, without underlying osseous abnormality, is rare. There is a predilection for infection to affect the lower cervical segments. We observed a strong association between cervical epidural spinal infection and spinal cord compromise, which makes prompt diagnosis and treatment mandatory.

Cervical Vertebrae↗
PubMed1999

Spondylodiskitis.

Explore the source record for details and available documents.

Discitis↗
PubMed1995

Vertebral osteomyelitis presenting as lumbar dysfunction: a case study.

Lumbar dysfunction is a common diagnosis that the physical therapist encounters on a daily basis. The etiology of the patient's symptoms can be mechanical or systemic, and this must be discerned so that appropriate care may be provided for the patient. When signs and symptoms are present that do not suggest a mechanical etiology, the physical therapist must be able to recognize this and refer the patient appropriately. This case study describes lumbar pain of an insidious onset in an otherwise healthy 32-year-old male and the evolution of systemic signs and symptoms which were initially thought to have a mechanical or nonsystemic etiology. Discussion is directed toward the clinical presentation of osteomyelitis, the importance of a thorough review of a patient's medical history, and a complete physical examination in determining if the presenting complaints are mechanical or systemic in etiology.

Adult↗
PubMed1994

Aspergillosis infection in neurosurgical practice.

Fungal infections including those due to aspergillus are rare in neurosurgical practice despite their possible inclusion in many differential diagnoses. Recently, these diseases have been diagnosed with increasing frequency, principally as opportunistic infections in patients undergoing treatment for diseases resulting in immune compromise. The epidemiology is poorly understood as mycoses are not notifiable diseases. We have recently been involved in the care of seven patients with aspergillosis between 1988 and 1991. Its presentation, with abscess formation, granulomas, the rhinocerebral form, meningitis, hydrocephalus and vascular involvement, is varied. The majority of cases were seen in immunocompromised patients following haematogenous dissemination from a pulmonary or gastro-intestinal focus. Direct spread from sinus infection has also been seen. The prognosis is poor despite modern antifungal treatment, which in part reflects the primary underlying condition.

Adult↗